理气化瘀消肿汤对肝硬化腹水患者的临床疗效

作者：陶运生  李猛  周泽林  刘盼盼  单云娇  吴福宁

单位：安徽中医药大学附属铜陵市中医医院 肝病脾胃病科 安徽 铜陵 244000

关键词：肝硬化 腹水 理气化瘀消肿汤 抗病毒 利尿

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出版年,卷(期):页码：2024,16(3):59-64

摘要：

摘要：目的 观察理气化瘀消肿汤对肝硬化腹水患者的临床疗效。方法 以2020年1月至 2022年12月于安徽中医药大学附属铜陵市中医医院就诊的102例肝硬化腹水患者为研 究对象进行回顾性分析。根据治疗方法分为西医对照组（51例）和中西医结合治疗组 （51例）。西医对照组患者采用常规西药利尿、护肝、抗病毒等治疗。中西医结合治 疗组患者在西医对照组治疗基础上加用理气化瘀消肿汤。比较两组患者治疗前和治疗 12周时中医症候积分，比较治疗前、治疗6周和12周时两组患者肝功能指标 [丙氨酸氨 基转移酶（alanine aminotransferase，ALT）、总胆红素（total bilirubin，TBil）、丙氨 酸氨基转移酶（aspartate transaminase，AST）、白蛋白（albumin，ALB）]、空腹体 质量、腹围、腹水深度及炎症指标 [包括白细胞介素（interleukin，IL）-6和肿瘤坏死 因子-α（tumor necrosis factor-α，TNF-α）]，记录不良反应发生情况。结果 治疗12周 时，中西医结合治疗组患者腹大如鼓（中位数：0分比2分）、胁肋刺痛（中位数：0分 比2分）、面色黯黑（中位数：0分比2分）、渴不欲饮（中位数：0分比2分）中医症候 积分显著低于西医对照组（P均＜ 0.05）。治疗6周和12周时，中西医结合治疗组患者 空腹体质量 [6周：（64.25 ± 5.41）kg比（67.47 ± 6.29）kg；12周：（60.53 ± 6.78）kg 比（63.35 ± 6.43）kg]、腹围 [6周：（88.76 ± 6.90）cm比（91.51 ± 4.36）cm；12周： （82.55 ± 7.65）cm比（86.27 ± 8.09）cm]、腹水深度 [6周：（3.35 ± 1.32）cm比（4.31 ± 1.59）cm；12周：（1.41 ± 0.50）cm比（3.39 ± 2.15）cm] 均显著低于西医对照组（P 均＜ 0.05）。治疗6周和12周时，中西医结合治疗组患者血清ALT水平 [6周：（87.69 ± 15.41）U/L比（102.15 ± 18.64）U/L；12周：（62.56 ± 6.48）U/L比（75.39 ± 9.55）U/L]、 AST [6周：（54.96 ± 12.51）U/L比（69.15 ± 13.47）U/L；12周：（37.02 ± 10.69）U/L 比（45.29 ± 11.87）U/L]、TBil [6周：（36.87 ± 10.32）μmol/L比（42.16 ± 9.78）μmol/L； 12周：（27.61 ± 7.47）μmol/L比（34.02 ± 8.69）μmol/L] 水平显著低于西医对照组， ALB水平 [6周：（32.51 ± 3.65）g/L比（30.14 ± 2.45）g/L；12周：（42.59 ± 5.84）g/L 比（35.61± 3.69）g/L] 显著高于西医对照组（P均＜ 0.05）。治疗6周和12周时，中西 医结合治疗组患者血清IL-6 [6周：（35.74 ± 4.63）ng/L比（41.08 ± 5.38）ng/L；12周： （20.69 ± 2.79）ng/L比（32.57 ± 4.20）ng/L]、TNF-α水平 [6周：（48.63 ± 6.19）ng/L比 （53.84 ± 7.35）ng/L，12周：（29.20 ± 4.06）ng/L比（38.75 ± 5.34）ng/L] 显著低于西医 对照组（P均＜ 0.05）。两组患者不良反应发生率（3.92%比1.96%）差异无统计学意义 （χ2 = 0.350，P = 0.554）。结论 理气化瘀消肿汤能够有效改善肝硬化腹水患者病情和肝 功能，降低患者空腹体质量、腹围和腹水深度，且有利于减轻炎性反应，安全性良好。

Abstract: Objective To observe clinical efficacy of Liqi Huayu Xiaozhong Decoction in liver cirrhosis patients with ascites. Methods A total of 102 liver cirrhosis patients with ascites in Tongling Traditional Chinese Medicine Hospital, Anhui University of Traditional Chinese Medicine from January 2020 to December 2022 were retrospectively analyzed. The patients were divided into Western medicine control group (51 cases) and integrated Chinese and Western medicine treatment group (51 cases) according to the treatment method. Patients in Western medicine control group received conventional Western medicine treatment such as diuresis, liver protection and antiviral therapy. Patients in integrated Chinese and Western medicine treatment group were treated with Liqi Huayu Xiaozhong Decoction on the basis of Western medicine control group. The traditional Chinese medicine symptom scores of patients in two groups were compared before and after 12 weeks of treatment. Liver function indicators [alanine aminotransferase (ALT), total bilirubin (TBil), aspartate aminotransferase (AST), albumin (ALB)], fasting body mass, abdominal circumference, ascites depth and inflammatory indicators [including interleukin (IL)-6 and tumor necrosis factor-α (TNF-α)] between the two groups before treatment, 6 weeks of treatment and 12 weeks of treatment were compared. The occurrence of adverse reactions were recorded. Results At 12 weeks of treatment, the traditional Chinese medicine symptom scores of abdominal distension (median: 0 score vs. 2 scores), rib pain (median: 0 score vs. 2 scores), dark complexion (median: 0 score vs. 2 scores), thirst and reluctance to drink (median: 0 score vs. 2 scores) of patients in integrated Chinese and Western medicine treatment group were significantly lower than those of Western medicine control group (all P ＜ 0.05). At 6 weeks and 12 weeks of treatment, the fasting weight [6 weeks: (64.25 ± 5.41) kg vs. (67.47 ± 6.29) kg; 12 weeks: (60.53 ± 6.78) kg vs. (63.35 ± 6.43) kg], abdominal circumference [6 weeks: (88.76 ± 6.90) cm vs. (91.51 ± 4.36) cm; 12 weeks: (82.55 ± 7.65) cm vs. (86.27 ± 8.09) cm] and ascites depth [6 weeks: (3.35 ± 1.32) cm vs. (4.31 ± 1.59) cm; 12 weeks: (1.41 ± 0.50) cm vs. (3.39 ± 2.15) cm] of patients in integrated Chinese and Western medicine treatment group were significantly lower than those of Western medicine control group (all P ＜ 0.05). At 6 weeks and 12 weeks of treatment, ALT [6 weeks: (87.69 ± 15.41) U/L vs. (102.15 ± 18.64) U/L; 12 weeks: (62.56 ± 6.48) U/L vs. (75.39 ± 9.55) U/L], AST [6 weeks: (54.96 ± 12.51) U/L vs. (69.15 ± 13.47) U/L; 12 weeks: (37.02 ± 10.69) U/L vs. (45.29 ± 11.87) U/L] and TBil [6 weeks: (36.87 ± 10.32) μmol/L vs. (42.16 ± 9.78) μmol/L; 12 weeks: (27.61 ± 7.47) μmol/L vs. (34.02 ± 8.69) μmol/L] levels of patients in integrated Chinese and Western medicine treatment group were significantly lower and ALB levels [6 weeks: (32.51 ± 3.65) g/L vs. (30.14 ± 2.45) g/L; 12 weeks: (42.59 ± 5.84) g/L vs. (35.61 ± 3.69) g/L] were significantly higher than those of Western medicine control group (all P ＜ 0.05). At 6 weeks and 12 weeks of treatment, IL-6 [6 weeks: (35.74 ± 4.63) ng/L vs. (41.08 ± 5.38) ng/L; 12 weeks: (20.69 ± 2.79) ng/L vs. (32.57 ± 4.20) ng/L] andT NF-α [6 weeks: (48.63 ± 6.19) ng/L vs. (53.84 ± 7.35) ng/L; 12 weeks: (29.20 ± 4.06) ng/L vs. (38.75 ± 5.34) ng/L] levels of patients in integrated Chinese and Western medicine treatment group were significantly lower than those of Western medicine control group (all P ＜ 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients (3.92% vs. 1.96%; χ2 = 0.350, P = 0.554). Conclusions Liqi Huayu Xiaozhong Decoction can effectively improve the condition and liver function of liver cirrhosis patients with ascites, reduce their fasting weight, abdominal circumference and depth of ascites, and is beneficial for reducing inflammatory reactions, with good medication safety.

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